Healthcare Provider Details

I. General information

NPI: 1699767301
Provider Name (Legal Business Name): PAUL D NELSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 S HERITAGE WOODS DR
APPLETON WI
54915-1408
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-225-7875
  • Fax:
Mailing address:
  • Phone: 920-748-7000
  • Fax: 920-748-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20430-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20430-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: